Health and Social Care Bill
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
In commenting on the level of nursing staff, will the hon. Gentleman observe that since the election, there has been a 5% improvement in the ratio of nurses to occupied beds in general and acute wards?
Andrew George
I am not in a position to doubt that figure. The question is whether the ratio is sufficient to ensure that there is safe staffing in our hospitals now, as the RCN identified after a recent survey. I understand the argument advanced by Ministers that it comes down to the management and the management of paperwork within hospitals, and is not just about staff-to-patient ratios. I do not want to have a debate just about staff -to-patient ratios, but that issue has been raised today and I believe that it resonates with people out there in the country, who can see that nurses in particular are struggling to provide adequate services within their hospitals. Those ratios have an effect on the level of care that nurses can provide, as has been found by a variety of reports. The problem is not down to the callousness of the nurses or untrained care assistants who provide the services—where that exists, it should clearly be rooted out of the service—but to whether staff resources are sufficient to maintain safe services on our hospital wards. I think the RCN is right to raise that issue.
That concern is relevant to ensuring that we have adequate local healthwatch services because it shows that we need independent scrutiny of the health service by a body that is not in the pocket of anyone, including the local authority, but that is able to scrutinise hospitals and speak out about staffing levels in its area. We cannot be dependent on the RCN reporting such matters to the Department and on there being top-down diktats that impose mandatory staffing levels that apply in all circumstances. Rather, there should be a local healthwatch that looks at the guidance and recommendations of the professional bodies and ensures that the services in its local hospitals are adequate to provide safe nursing and hospital care. That is why it is important to ensure that the local healthwatch bodies are, as far as is possible, independent of any external influences, whether from the Department, the NHS Commissioning Board, clinical commissioning groups or the local authority. That is where I shall take my arguments.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of the right hon. Member for Leigh (Andy Burnham) that there was an emergency warranting this debate. I regret that he has let you down. It turns out there was no emergency, there was no argument, and there was no point.
Ostensibly, the debate is to consider the Department of Health’s transition risk register. The House considered that on 22 February, and by a majority of 53 the House decided that it did not support the publication of the risk register. We further considered that matter in the debate on 13 March. I think that the views of this House should be respected.
Yesterday, in another place, Lord Owen proposed an amendment, the purpose of which was to delay consideration of Third Reading in the House of Lords until the publication of “reasons” by the first-tier tribunal and the Government’s response. That amendment was defeated by a majority of 115. I remind the House that the Government do not command a majority in the House of Lords. That proposal was defeated by a substantial majority on the balance of the argument.
I will not repeat what I said in the debate on 22 February, but let me just add three things. First, as my noble Friend Lord Howe told the House of Lords yesterday, the risks and other impacts of the Bill were fully disclosed, not least in the impact assessments—a 200-page document—published alongside the Bill; in the NHS operating frameworks; in transition letters from the NHS chief executive and others; and in the full description of the risk headings that Lord Howe set out to the House of Lords on 28 November. I regret to say that it sounds to me that no Labour Members—with, I suspect, the exception of the right hon. Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham)—have taken the trouble to read the debates in the House of Lords.
Secondly, as my hon. Friend the Member for Banbury (Tony Baldry) made clear, Lord Wilson of Dinton, a former Cabinet Secretary, told the House of Lords yesterday that he has deep concerns about the Information Commissioner’s decision and its negative impact on the safe space within which officials give frank advice and act as a “devil’s advocate” to Ministers.
John Healey
The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?
Mr Lansley
The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Mr Lansley
No.
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Duncan Hames (Chippenham) (LD)
The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?
Mr Lansley
As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.
Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:
“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”
I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.
The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce
“practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.
The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that
“we will deliver up to £20 billion of efficiencies in the frontline NHS”.
Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:
“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.
He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.
The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.
I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.
NHS Pay Review Body
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am responding on behalf of my right hon. Friend the Prime Minister to the 26th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 8298). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the NHSPRB for their report.
We welcome the NHS Pay Review Body’s 26th report, note its observations and accept its recommendations in full. In the light of a tough economic climate, I am pleased to confirm that lower paid NHS staff earning £21,000 or less will receive a flat rate increase of £250 from 1 April 2012. This will support continuing NHS service improvements and the position of lower paid NHS staff.
Review Body on Doctors' and Dentists' Remuneration
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am responding on behalf of my right hon. Friend the Prime Minister to the 40th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 8301). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the DDRB for their report.
We welcome the 40th report of the Review Body on Doctors’ and Dentists’ Remuneration and note its observations and recommendation to the Scottish Government. The Scottish Government are still considering the recommendation and expect to be in a position to make a decision by the end of the month. We will take forward the suggested actions, which will help us continue to improve our support for the DDRB’s important work.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 7 months ago)
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Andy Burnham
No. I have been listening to the strictures from the Chair, and I want to get into my speech so that Back-Bench colleagues have a chance to contribute.
That takes us straight to the heart of the predicament in which we find ourselves. There is huge concern in the country about the Bill, but the Government and Parliament—
The Secretary of State for Health (Mr Andrew Lansley)
Will the right hon. Gentleman give way?
Andy Burnham
I will in a moment.
There is huge concern in the country about the Bill, but the Government and Parliament are seen simply not to be listening. I give way to the Secretary of State, and I hope that he might prove us wrong.
Mr Lansley
I am grateful to the right hon. Gentleman, but before we move beyond that point will he confirm that Dr Chand is an adviser to the Labour party, which inspired the petition? Further, given that Dr Chand has called on the British Medical Association to take strike action against the Bill, does the right hon. Gentleman share that view, or will he disown him?
Andy Burnham
Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.
The Secretary of State for Health (Mr Andrew Lansley)
As a learned man, Mr Deputy Speaker, you will recall that Plato said that
“empty vessels make the loudest sound”.
The right hon. Member for Leigh (Andy Burnham) has been a study in this: as his arguments have diminished, so his tone has become more strident. By the end of his speech, he was simply shouting slogans. I listened carefully to his speech, but in vain, for evidence of an argument, still less of an Opposition policy.
I ask the House to reject the motion, which is a desperate ploy from a desperate party. The House scrutinised and approved the Bill, with amendments. following a substantial and highly constructive engagement right across health and care services and with the independent NHS Future Forum. We accepted all their recommendations. The chairman of the British Medical Association Council said at the time that the recommendations
“address many of the BMA’s key concerns”.
Dr Clare Gerada, the chair of the Royal College of General Practitioners, said that
“we are reassured that things are moving in the right direction”.
Yes, things have moved in the right direction, including, apparently, Dr Gerada, encouraged by her council.
In the other place, things have moved in the right direction, too. We have had hours of constructive debate leading to further positive amendments, including amendments to put beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service, and a duty on the Secretary of State to have regard to the NHS constitution; amendments to make it clear that Monitor will have the power to require health care providers to promote integration of NHS services, enabling Monitor to use its powers to support integration and co-operation in the interests of patients; and amendments conferring new responsibilities on the NHS Commissioning Board and clinical commissioning groups to play an active role in supporting education and training, and requiring providers to co-operate with the Secretary of State when exercising his duty to secure an effective education and training system. All those amendments were positively accepted in the Lords.
Mr George Howarth
The Secretary of State quoted Plato earlier. Does he recall the advice that Cromwell gave to Members of the Long Parliament—that they had stayed in their place for too long and to no useful purpose? Is that not advice that he might take?
Mr Lansley
I do not think the right hon. Gentleman should quote Cromwell to a Cambridgeshire MP; I think I know more about Cromwell than he does. [Hon. Members: “Ooh!”] I might also tell him—
Michael Dugher (Barnsley East) (Lab)
What do you know about the health service?
Mr Lansley
What do I know about the health service? I have been at the Government and Opposition Dispatch Boxes for nearly nine years speaking on behalf of the national health service. Before that I was on the Select Committee on Health, looking out for the interests of the health service, and before that my father was working—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Front Benchers need to be a little calmer. A lot of Members want to be called, and we want to hear the Secretary of State.
Mr Lansley
Let me just say this to the hon. Member for Barnsley East (Michael Dugher), who is sitting on the Opposition Front Bench. There may be many things that we can debate in this House, including the policies, but I deeply resent any implication that I do not care about the national health service. I believe that I have demonstrated that I do; and his hon. Friends—and, to be fair, the right hon. Member for Leigh—have made that absolutely clear, time and again. Dr Clare Gerada, on behalf of the Royal College of General Practitioners, has said clearly that she recognises the Prime Minister’s and my passion and commitment and that of the Prime Minister to support the national health service.
Stewart Hosie (Dundee East) (SNP)
The Secretary of State said some moments ago that the Bill had all been debated in this House, but of course it has not. Possibly the most damaging aspect financially to the NHS outside England is the increase in usage of the private sector in the NHS in England to 49%. That has never been debated in this House, has it?
Mr Lansley
I am afraid that the hon. Gentleman is completely wrong. The private income cap for foundation trusts was debated fully in Committee in this House, and it has been debated again in another place. The reason for the so-called 49% was simply that Members in another House said that they wanted to be absolutely clear that the principal legal purpose of foundation trusts is to provide services to the NHS, and therefore that, by definition, a foundation trust could not have more of its activity securing private income than NHS income, hence the 49%. But in truth, the safeguards that are built in make it absolutely clear that, whatever the circumstances and whatever their private income might be—from overseas activities or overseas patients coming to this country—foundation trusts must always demonstrate that they are benefiting NHS patients. That is why, I remind the House again, the foundation trust with the highest private income—27%—is the Royal Marsden, which delivers consistently excellent care for NHS patients.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend share my absolute astonishment at Labour Members’ collective amnesia when it comes to the 13 years of mixed-sex wards and rising levels of MRSA and C. difficile that they presided over, along with a failed patient record system that has cost billions?
Mr Lansley
My hon. Friend is absolutely right, and I will come to some of those points. However, I might just say that, in the space of the last few days, we have had an opportunity to demonstrate that Labour signed up to an enormous, centralised, top-down NHS IT scheme that was never going to deliver, was failing to deliver and was costing billions.
Karl Turner (Kingston upon Hull East) (Lab)
Will the Secretary of State give way?
Mr Lansley
No.
In the space of under two years, my right hon. and hon. Friends at the Department and I have delivered a reduction approaching £2 billion in the cost of the NHS IT programme. That will enable us to empower services right across the country to be better users and deliver better IT systems.
Duncan Hames (Chippenham) (LD)
Further to the list of changes to the Bill that the Health Secretary has outlined, will he confirm that it no longer imposes reviews by the Competition Commission on the NHS, therefore ensuring that it is not treated in the same way as any private industry would be?
Mr Lansley
That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[Interruption.] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.
Simon Hughes
Will the Health Secretary amplify his answer to our Scottish National party colleague, the hon. Member for Dundee East (Stewart Hosie), and make it quite clear that both Government policy and, now, the construction of the Bill not only prevent private sector activity from going out of the health service in terms of finance, but restrict the method of expanding private sector activity? The controls are now in the Bill, even if they were not at the beginning.
Mr Lansley
There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.
Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything. They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that
“to safeguard the NHS in tougher fiscal times, we need sustained reform.”
The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that
“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.
I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[Interruption.] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.
John Pugh (Southport) (LD)
The right hon. Gentleman has just mentioned reform. In 2009, he said in this place:
“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]
What did he mean by that?
Mr Lansley
We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.
When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.
Let me return to the Labour manifesto—[Interruption.] Labour Members do not like to hear this. It stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.
Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.
Mr Lansley
Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:
“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.
They continued:
“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—
precisely the things that the NHS needs for the future.
Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was
“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Mr Lansley
I will give way in moment. The right hon. Gentleman said he was in favour of practice-based commissioning. In 2010, he was the Secretary of State and was in charge of the manifesto, yet practice-based commissioning disappeared out of the Labour manifesto —it was not there at all. After the election, he pops up and says, “Oh, we are in favour of it again”. The truth is that practice-based commissioning was always the right idea: the Labour Government did not do it; the primary care trusts suppressed it. The Bill makes it possible for clinical commissioning groups to take responsibility and for doctors and nurses to design and deliver better services. Because of this Bill, it will happen—and it will not be suppressed by a top-down bureaucracy.
Andy Burnham
I made the Secretary of State an offer in my opening remarks. I said I would work with him to introduce his vision of clinically led commissioning, but he seems strangely silent about that and is pursing a very partisan tone. Will he confirm that he could introduce GP-led commissioning without any need for legislation—and without all the upheaval that is coming with his reorganisation?
Mr Lansley
The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.
Angie Bray
I thank my right hon. Friend for that, and I thank him, too, for coming to Acton last week and spending a long evening in a room full of health professionals—doctors, dentists and pharmacists. Does he agree that there was a real desire in that room to engage constructively in discussion on the reforms rather than to turn their back on them, as the Labour party would?
Mr Lansley
I am grateful to my hon. Friend for her initiative in bringing doctors, dentists and nurses together to have that conversation. I really appreciated it, and I thought that it illustrated exactly what I have found—that, although not everybody in the room agreed with the Bill—[Laughter]—many did. Contrary to what I see on the Labour Benches, they all wanted to design better services for patients. They cared about patients and engaged in a proper debate about how to achieve that.
I am still trying to find out what it is in the Bill that the right hon. Member for Leigh is against. Is it the fact that the Bill strengthens the NHS constitution? He should be proud of that; he introduced it. For the first time, however, the Bill requires the Secretary of State to have regard to it and the NHS Commissioning Board and clinical commissioning groups to promote it. He is not against that, I presume.
What about the fact that, for the first time, the NHS Commissioning Board and commissioners will have a duty to promote integration throughout health and social care? Is the right hon. Gentleman against integrated care? I do not know. Let me try another question. What about the prohibition in clauses 146, 22 and 61 of discrimination in favour of private providers, which is in legislation for the first time? The right hon. Gentleman may be against that, because when his party was in office, that is what the Government did. They discriminated in favour of private sector providers, and we ended up with £250 million being spent on operations that never took place and the NHS being paid more for operations when it was not even allowed to bid for the work.
What about the creation of a strong statutory voice for patients through HealthWatch? The Labour Government destroyed the community health councils, they destroyed patient forums, and they left local involvement networks neutered. When they were in office, they were pretty dismissive of a strong patient voice. Well, we on the Government Benches are not, and the Bill will establish that patient voice. Is the right hon. Gentleman against all trusts becoming foundation trusts? The Bill will make that happen, and will support it—oh, no, I forgot: according to the Labour party manifesto, Labour wanted all trusts to become foundation trusts.
Let us keep moving through the Bill. Is the right hon. Gentleman against directly engaging local government in the commissioning of health services, integrating health and social care, and leading population health—public health—improvement plans? I ask the question not least because Labour local authorities throughout England are in favour of that. They want to improve the health of the people whom they represent. Is the right hon. Gentleman against local democratic accountability? The list could go on. Is he against the provision of a regulator—Monitor—whose duty is to protect the interests of patients by promoting quality, stopping anti-competitive practices that could harm patients, supporting the integration of services, and securing the continuity of services? Is he against that? It is in the coalition agreement, but I do not know whether the right hon. Gentleman is against it or not, because he does not say.
Is the right hon. Gentleman against statutory backing for the National Institute for Health and Clinical Excellence to support its work on quality? I do not know; we have not heard. Is he against developing the tariff so that it pays for quality and outcomes, not for activity? He knows that that has to happen, and he knows that it has been the right thing to do for the best part of a decade, but we have no idea whether he is against it now.
I cannot discover what the right hon. Gentleman is actually against. He sits there and says that he is against the Bill, but he is not against anything that is in the Bill. He is against the Bill because he has literally made up what he claims it says. He says that it is about privatisation—
Mr Lansley
All right, I will give way to the right hon. Gentleman one more time. Come on, then: let us find out what he is against.
Andy Burnham
I will tell the Secretary of State what I am against. I am against the rewriting of the entire legal structure of the national health service to plant market forces at the centre of the system, and to pit doctor against doctor and hospital against hospital. That is what I am against, it is what 170,000 people signed a petition against, and it is what the overwhelming consensus of health professionals is against. Would the Secretary of State not do well to listen to them for once?
Mr Lansley
So now we know, Mr Deputy Speaker. It is sheer invention. There is nothing in the Bill that creates a free-for-all. There is nothing in it that creates a market of that kind. The Bill means competition for quality, not price. It gives patients choice—and the Labour party’s manifesto was in favour of giving patients choice. Competition is not being introduced to the NHS by the Bill; it is being channelled in the interests of patients to support quality throughout the NHS.
The Opposition talk about privatisation. As I said to my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), there is nothing in the Bill that allows any privatisation of NHS services. There is nothing in it that promotes such a privatisation.
The left-leaning papers talk about privatisation at Hinchingbrooke hospital because Circle is an independent mutual organisation. That is interesting, because the process for the franchising out of the management of Hinchingbrooke was started by the right hon. Gentleman when he was Secretary of State. So there we are: the only secret Tory plan that Labour can find turns out to be a Labour plan.
Paul Uppal (Wolverhampton South West) (Con)
The real issue in the debate is between long-termism and short-termism. Is not the reality that the Labour Government went aggressively down the route towards private finance initiatives, burdening so many of our foundation trust hospitals with debt that was unnecessary?
Mr Lansley
My hon. Friend makes an important point. When Labour Members talk about the private sector in the NHS, they leave out of account the fact that not only did they give the private sector a sweetheart deal to get it into the independent sector treatment centres, but they have left us with 102 hospitals that were built by the private sector and £67 billion of debt to the NHS. They wandered around the country saying, “Look how we’re spending all your money to build all these new hospitals,” but they did not spend the money to build the new hospitals. They have left the NHS to have to deal with it now, which is why I am having to support hospitals that have unsustainable private finance initiative debt that the right hon. Member for Leigh and his colleagues did not deal with.
What do we have? We have policies that the right hon. Gentleman disowns, and we have nothing to replace them with. We have political opportunism, distortions dressed up as arguments, and a shameful campaign to scare people about a Bill that, in reality, is about strengthening the NHS for the benefit of patients.
Of course, if we want to see what Labour would do, we only have to look at the situation in Wales. I have to hand a Wales Audit Office bar chart; I shall hold it up so Opposition Members can see it. One bar shows rising real-terms expenditure on the NHS in England, and the blue bar shows rising real-terms expenditure on the NHS in Scotland, while the green bar shows the rate for Northern Ireland, where the rise is lower. Another bar, however, shows a very large real-terms cut in NHS spending in Labour-run Wales. Labour in Wales did not just agree with the right hon. Gentleman that it would be “irresponsible” to increase NHS spending; Labour in Wales went further, and cut spending.
In order to see the result of that, we must look at performance. In England, 91% of patients are seen and treated within 18 weeks, compared with just 68% in Wales. In England, only 1.4% of patients waited over six weeks for diagnostic tests; in Wales, 29% waited over six weeks. In Wales, Labour says it wants to insulate the NHS against reform. It ought to adopt it, however, because all that is happening in Wales is that the Labour party is, once again, putting politics before patients.
It is patients who should be at the heart of the NHS —patients and those who care for them. This Bill is simply the support to a far more important set of changes, which make shared decision-making with patients the norm across the NHS, which bring clinical leadership to the forefront of the design and delivery of health and care services, which make local government central to planning for health and care, which strengthen the patient voice, and under which the NHS is open about the results we achieve and how to improve those results so we genuinely match the best in the world. We will continue to work with the royal colleges, and others with an interest in the future of the NHS, to implement our plans, so that we provide the best possible care for patients. The right hon. Gentleman’s motion and speech gave no credit to the NHS for what it is achieving, but I will.
We are proud of the services we deliver for patients: the lowest ever number of patients waiting over six months for treatment—[Interruption.] Labour Members do not like to listen to this, but it is the reality. Average time spent waiting for treatment is lower than at the last election. The number of patients waiting over a year for treatment has more than halved since the election. MRSA and C. difficile are at their lowest ever levels. There are more diagnostic tests—up by 300,000 over a year. There is more planned care, and there are fewer unplanned emergency admissions to hospital. Some 11,800 patients have benefited from the cancer drugs fund, and 990,000 more people have had access to NHS dentistry, while mixed-sex accommodation is down by 95%.
Mr Lansley
No, because I am going to tell the right hon. Gentleman what he did not admit. Reform is going ahead. We are delivering efficiencies across the NHS.
Mr Lansley
All right, I will give way, but the right hon. Gentleman might like to explain why in the year before the election the administration costs of the NHS rose by 23% and he added more than £320 million to the administration costs of primary care trusts and strategic health authorities, but in the year since, we have cut those costs. Absolutely contrary to what he said—because he was completely wrong—we are on track to deliver the Nicholson challenge. We delivered £2.5 billion in savings in the first six months of this year, having delivered £4.3 billion in savings during the course of the last financial year. Come on: explain that one.
Andy Burnham
I should just point out that the Secretary of State is trading on the successful legacy he inherited from Labour: the lowest ever waiting lists; the highest ever patient satisfaction. Let me leave that to one side, however. We on the Opposition Benches have noticed that he has not once mentioned his tribunal defeat on the NHS risk register, and all the achievements he just reeled off are at risk, are they not, because of this misguided reorganisation? I ask him to answer this point today: will he now comply with the ruling of the Information Tribunal, publish this risk register today, and let the public know the full truth about what he is doing to their national health service?
Mr Lansley
I was right, was I not, that the weaker the right hon. Gentleman’s argument, the stronger the tone? My noble Friend Earl Howe answered a private notice question in the other place yesterday, and the position is absolutely as he described it: we were right to go to appeal, as the appeal demonstrated, because the tribunal agreed that we should not publish the strategic risk register. The decision of the tribunal was that it took the view that we should publish the transition risk register, but it did not publish its reasons. Given the simple fact that there is considerable overlap between the strategic register and the transition risk register, I find it extremely difficult to know what the tribunal’s reasons are, so we will see what its reasons are.
Mr Lansley
I will not give way.
Let me just make it absolutely clear that reform is happening and it will be supported by the Bill: nearly £7 billion has already been saved to reinvest in front-line care; we have 15,000 fewer non-clinical staff; we have 5,800 fewer managers and 4,100 more doctors—since the election, we have had more qualified clinical staff; there are 890 more midwives since the election and a record number in training; we have 240 clinical commissioning groups covering England, leading on commissioning from April on up to £60 billion-worth of services; and the ratio of nurses to beds in hospital has gone up.
Labour’s motion is politics masquerading as principle, and it is synthetic anger. I would take the right hon. Gentleman’s campaign more seriously if his own leader could have been bothered to turn up to his NHS rally, rather than taking a Rolls-Royce to a football game. This is empty rhetoric from an empty vessel; this is no policy, only politics; and this is a leader who treats his party’s campaign with disdain. The House should have no truck with them, and I ask it to reject the Labour motion.
Valerie Vaz
I am sorry, but I have nearly finished my speech and must press on.
There was a chorus of disapproval from professionals when the White Paper was published, as they wanted more information. As Rogers and Walters say in the sixth edition of “How Parliament Works”, if there is pre-legislative scrutiny, Ministers have less political capital at stake and changes are not seen as defeats; the scrutiny of a Bill in draft gives higher quality legislation. That is not a description of the Health and Social Care Bill. The pre-legislative scrutiny was in the Secretary of State’s head, not in a draft Bill.
What about my constituent Stephen Wood, who went to his local GP’s surgery only to be told that doctors would only refer him to a consultant privately, not on the NHS, as he had apparently used up his budget?
Valerie Vaz
It is true. This has become personal. The NHS is an organisation in which miracles sometimes happen, which is why people are fighting to protect and save the very essence of its existence. Those who have paid their taxes do not want the Bill, and the health professionals do not want it. From all parties, professionals and patients in the NHS, we can say that we oppose the Bill, and when the NHS unravels, as it is now beginning to, we can say, “We told you so.” I support the motion.
NHS Pension Scheme (England and Wales)
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
On December 2011, I reported to the House that a heads of agreement had been reached on a new NHS Pension Scheme for England and Wales for introduction in 2015. The heads of agreement set out the Government’s final position on the main elements of scheme design.
Following this, my Department has been engaged in detailed discussions with health sector trade unions and employer representatives over the remaining details for the new NHS pension scheme. I can now report to the House that these discussions have concluded and the outcome reflected in a proposed final agreement. The headline elements of the proposed final agreement remain unchanged from those set out in my previous statement to the House concerning pension reform on 20 December 2011.
The Government have made it clear that the proposed final agreement represents our final position on scheme design. The final scheme design is conditional on acceptance by trade unions of the proposed final agreement. Trade unions have agreed to take this proposed final agreement to their Executives as the outcome of negotiations. Furthermore, the proposed final agreement includes a commitment by trade unions to seek Executives’ agreement to the cessation of any further industrial action on pension reform.
The core parameters of the new scheme are set out below:
a. a pension scheme design based on a career average revalued earnings methodology;
b. an accrual rate of l/54th of pensionable earnings each year with no limit to pensionable service;
c. revaluation of active members’ benefits in line with the consumer price index plus 1.5% per annum;
d. a normal pension age equal to the state pension age, which applies both to active members and deferred members (new scheme service only). If a member’s state pension age rises, then their normal pension age will do so too for all post-2015 service. Those within 10 years of their current normal pension age are excluded and accrued rights will also be related to current normal pension age;
e. pensions in payment to increase in line with inflation (currently consumer price index);
f. benefits to increase in any period of deferment in line with inflation (currently consumer price index);
g. member contributions on a tiered basis to produce a total yield of 9.8% of total pensionable pay in the scheme;
h. optional lump sum commutation at a rate of £12 of lump sum for every £1 per annum of pension foregone up to the maximum limit on lump sums permitted by HM Revenue and Customs;
i. the current flexibilities in the 2008 section will be included in the 2015 scheme—early/late retirement factors on an actuarially neutral basis, draw down of pension on partial retirement and being able to retire and return to the pension scheme;
j. ill-health retirement pensions to be based on the current ill-health retirement arrangements but with enhancement for higher tier awards to be at the rate of 50% of prospective service to normal pension age;
k. spouse and partner pensions to continue to be based on an accrual rate of 1/160th. For deaths in retirement, spouse and partner pensions will remain based on pre-commuted pension;
l. the current arrangements for abatement (for service accrued before and after 2015) will be retained;
m. the lump sum on death in service will remain at twice actual pensionable pay;
n. for members who in the new scheme have a normal pension age higher than 65 there will be an option in the new scheme to pay additional contributions to reduce or, in some cases, remove any early retirement reduction that would apply if they retire before their normal pension age. Only reductions that would apply in respect of years after age 65 can be bought out and the maximum reduction that can be bought out is for three years (that would apply to a member with a normal pension age of 68 or higher);
o. added years contracts in the 1995 section will continue on compulsory transfer to the 2015 scheme;
p. arrangements to purchase additional pension will continue;
q. the public sector transfer club will continue and further consideration will be given to the best way of operating it in the reformed schemes; and
r. there will be an employer contribution cap.
The Government Actuary’s Department (GAD) has confirmed that this scheme design does not exceed the cost ceiling set by the Government on 2 November 2011. The proposed final agreement and GAD verification have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The documents are also available at:
www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133003.pdf
Whistleblowing and the NHS Constitution
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
On 9 June 2010, I announced a full inquiry into the failings at Mid Staffordshire NHS Foundation Trust and gave a commitment to
“Reinforce the NHS constitution to make clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing”.
The Department of Health ran a full public consultation on a set of proposals for changes to the NHS constitution in respect of whistleblowing and published the Government’s response to that consultation, on 18 October 2011, setting out a commitment to making the changes in early 2012.
I have today published a revised NHS constitution which highlights the existing rights of NHS staff to raise concerns without fear of detriment and makes it clear that it is the right and duty of all NHS workers to report bad practice or any mistreatment of patients receiving care from the health service at the earliest opportunity.
Changes to the constitution add:
an expectation that staff should raise concerns at the earliest opportunity;
a pledge that NHS organisations should support staff when raising concerns by ensuring their concerns are fully investigated and that there is someone independent, outside of their team, to speak to; and
clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.
These changes are part of a series of measures intended to highlight the importance of whistleblowing in the NHS. This Government have already issued unequivocal guidance to NHS organisations that all their contracts of employment should cover staff whistleblowing rights and amended the NHS staff terms and conditions of service handbook for those staff on Agenda for Change terms and conditions to include a contractual right to raise concerns. We have also issued guidance to the NHS on supporting and taking action on concerns raised by staff.
Enshrining whistleblowing in the constitution will contribute to further raising the profile of whistleblowing and play an important role in creating a culture where staff will be able to raise genuine concerns in good faith, without fear of reprisal.
I recently announced that the Department of Health has put in place a new and improved contract for the provision of a confidential whistleblowing helpline for NHS staff to provide them with advice on how to raise concerns and what legal protections are available to them when they do. The new contract provides for a free phone service and extends the provision of the contract to staff working in social care.
The revised NHS constitution has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Reviewing and Strengthening the NHS Constitution
Lord Lansley Excerpts(12 years, 7 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
As Secretary of State for Health, I have a duty, under the Health Act 2009, to publish a report on how the NHS constitution has affected patients, staff, carers and the public by 5 July 2012.
The Government are committed to the common set of principles and values established by the NHS constitution, and have made a number of amendments to the Health and Social Care Bill to strengthen its influence on the NHS.
The statutory requirement for a report on the impact of the NHS constitution provides an excellent opportunity to assess the contribution it has made to reinforcing the principles and values of the NHS, supporting high quality patient care and ensuring that patients, the public and staff are aware of their rights, as well as what they can contribute. The report will help to inform efforts to fully embed the constitution in the everyday work of the NHS, including the plans of the NHS Commissioning Board (NHSCB) and clinical commissioning groups (CCGs) to fulfil their duties to promote the NHS constitution.
In order to make the most of this opportunity, I am keen to have a wide range of advice and I have therefore asked Professor Steve Field to chair an independent Future Forum working group to advise me on the NHS constitution. The Future Forum group will use a wide variety of information, including surveys, workshops, performance data, and patient experience reports to examine what effect the constitution has had on the NHS and will then advise me on how best to reflect this in my report.
Following the report, I have also asked the new Future Forum group to advise me whether there is any scope for strengthening the NHS constitution to support the fair and effective operation of the NHS. Both the group and the Government will engage with key NHS, professional and patient organisations in considering the potential for changes, before a full public consultation in autumn 2012. Any amendments to the NHS constitution would then come into effect by April 2013.
Between them, this work and the new duties on the NHS constitution contained in the Health and Social Care Bill, which will require NHS bodies to have regard to the constitution and for the NHSCB and CCGs to promote the constitution, will strengthen both the contents of the NHS constitution and the role it plays in the NHS.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 8 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Health and Social Care Bill following a letter from the Deputy Prime Minister to MPs and peers and the Government’s response.
The Secretary of State for Health (Mr Andrew Lansley)
I am glad to have this opportunity again to set out the purposes of the Health and Social Care Bill. It will give patients more information and choice, so that they can share in decision-making about their care. It empowers front-line doctors and nurses to lead the delivery of care for their patients. It cuts out two tiers of bureaucracy and strengthens the voice of patients and the role of local government in integrating services and strengthening public health.
The values of the Bill are simple: putting patients first, trusting doctors and nurses, focusing on results for patients and maintaining the founding values of the NHS. We are constantly looking to reinforce those values, strengthening the NHS to meet the challenges it faces. We know change is essential; we will not let the NHS down by blocking change. Throughout the development and progress of this Bill, we have engaged extensively with NHS staff, the public, and parliamentarians.
The Health and Social Care Bill is the most scrutinised public Bill in living memory—[Interruption.] With over 200 hours of debate between the two Chambers and 35 days in Committee, we have ensured that Members and peers have had every opportunity to examine, understand and amend the Bill to—[Interruption.]
Mr Speaker
Order. I granted this question because I want Members to have the chance to scrutinise the Government of the day, but courtesy dictates that the Secretary of State’s statement must be heard.
Mr Lansley
Thank you, Mr Speaker.
We have made this legislation better and stronger. We have made significant changes to the Bill, including in response to the NHS Future Forum’s work and we have been open to any further changes that would improve or clarify the Bill. For example, so far in the Lords, the Government have accepted amendments tabled by a number of Cross-Bench, Liberal Democrat and Labour peers.
Yesterday, my right hon. Friend the Deputy Prime Minister and Baroness Williams wrote to their Liberal Democrat colleagues explaining their support for the Bill, with those changes and some further amendments they wish to see. They said, for example, how we must
“rule out beyond doubt any threat of a US-style market in the NHS”.
I wholeheartedly agree. The Bill is about quality, not competition on price. It will not permit any NHS organisation to be taken over by the private sector. It will put patients’ interests first. The Bill does not permit any extension of charging, and care will be free, based on need. Where the doctors and nurses on the ground know that competition is in the best interests of their patients—where it is based entirely on the quality of the care and treatment provided and not in any way on the price of that care and treatment—then competition can play an important role in driving up standards throughout the NHS.
We will not see a market free-for-all or a “US-style” insurance system in this country. I believe in the national health service. I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs. We—and I do mean all of us on the Government Benches—are using the debates in the Lords further to reassure all those who care about the NHS. I am grateful for this chance to reassure all my hon. Friends regarding the positive and beneficial effects of debate in the other place and about the work we are all doing to secure a positive future for the NHS.
Andy Burnham
On Friday, the Prime Minister promised there would be no more amendments, and yesterday lunch time the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) said that the whole Government backed the Bill as it stood, but hours later the Deputy Prime Minister called for changes to a flagship Bill that he has supported all the way. The Government appear to be in complete disarray—or perhaps this was pre-agreed coalition choreography for the Deputy Prime Minister to save face. Either way, this House is entitled to ask, “What is going on?” The NHS matters too much for us to allow it to be carved up in the unelected House in cosy coalition deals, so we are grateful, Mr Speaker, that you have brought Ministers here today to start providing some answers.
First, on the process, will the Secretary of State tell the House when he was first made aware of the Deputy Prime Minister’s letter? Was he consulted about its contents in advance and did he consent to the apparent change of policy or was he overruled by the Deputy Prime Minister? Who is in charge of health policy? Is anyone in charge?
Secondly, on policy, will the Secretary of State update the House on the precise detail of the changes that the Deputy Prime Minister is seeking in the five areas he identifies? For instance, we hear that the Deputy Prime Minister, having previously defended the 49% private patient income cap for foundation trusts, now wants “additional safeguards”. What are those safeguards? Are the changes still under discussion or do they now represent Government policy? Yesterday, the Liberal Democrats played up the changes, but the Secretary of State’s Department has dismissed them as minor. Is his view the same as ours that the amendments do not affect the substance of his Bill but rather are cosmetic changes designed to make the Deputy Prime Minister look good in advance of his spring conference?
The Prime Minister has been clear: this Bill is about competition at the heart of the health service. The Deputy Prime Minister has supported it all the way. Are not these just empty gestures designed to save face? This is a bad Bill that cannot be amended. Last week, the president of the Lib Dems spoke for his party when he admitted that the Bill should have been dropped. Does that not explain what this posturing is all about? In their heart of hearts the Liberal Democrats hate this Bill but have not had the guts to stand up to the Prime Minister and say so. Both coalition parties are putting their political pride before the best interests of the NHS. Is it not time for them to do what they said they would do at the start—listen to doctors and nurses and drop this Bill?
Mr Lansley
I am not sure the right hon. Gentleman even read the Deputy Prime Minister’s letter, judging from what he has just said. I will tell him exactly what the process is. The process is for detailed discussion in another place. There were 15 days of debate in Committee in another place. It is the habit in another place not to amend the Bill in Committee, but to use those debates in Committee as a basis for amendment on Report. The process is straightforward. My right hon. Friend the Deputy Prime Minister, together with Baroness Shirley Williams, explained to their Liberal Democrat colleagues some of the amendments on which we have been working together in order to make sure that there is further reassurance. [Interruption.] That is literally true.
Let me put the right hon. Gentleman right about something. What is at the heart of the Bill is improving the quality of care for patients. I note that he did not quote me or represent that he was quoting me. I have never said that competition is at the heart of the Bill. Competition is a means to an end, not an end in itself. The purpose of the Bill is to achieve quality. Where competition enables us to deliver better quality for patients, we should use it. Where integration of services and an absence of competition is in the interests of patients in delivering quality, that is the basis upon which the NHS should proceed. The Bill has been tremendously strengthened and is now a long-term sustainable basis for the NHS to deliver the quality of care for patients that we are looking for, while maintaining all the values of the NHS.
Mr Stephen Dorrell (Charnwood) (Con)
Has my right hon. Friend yet been able to understand how it can be that a party which, when in government, promoted practice-based commissioning that involved GPs in commissioning, promoted private sector investment in NHS institutions, and promoted the commissioning of care from private sector providers where that was in the best interests of patients now thinks all those principles undermine the national health service to which he, we and presumably the Opposition are still committed?
Mr Lansley
My right hon. Friend makes extremely good points. It is interesting that the right hon. Member for Leigh (Andy Burnham) appears to be trying to represent us as not agreeing about matters. He is chronically incapable of agreeing with himself. In June 2006 the then Prime Minister, Tony Blair, said that what the NHS needed in future was foundation trusts, practice-based commissioning, more involvement for the private sector and payment by results. The thing is that Labour in office did not achieve any of those things. It is only through the mechanism of the legislation that we are putting together that we are going to enable the NHS to achieve those things in a way that does not entail all the difficulties that Labour had, such as getting the private sector involvement with the NHS wrong. We are going to get those things right.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State agree that the Salisbury convention requires the House of Lords not to reject a measure if it has an electoral mandate? As all the parties in the House were mandated not to totally reorganise the national health service, would it not be wholly proper for the Liberal Democrats in the Lords to have some guts, join with Labour and Cross Benchers and vote the whole measure down?
Mr Lansley
The right hon. Gentleman is completely wrong about that. Perhaps he was not here last Wednesday when we debated health matters. [Hon. Members: “He was.”] Well, then he did not listen. I set out very clearly how the Bill was responding to the manifesto mandate that we in our party had, and it was a manifesto mandate that the Liberal Democrats brought to the coalition Government, not least in relation to the role of local government, bringing greater democratic accountability, which is precisely how some of these things have been achieved. If the right hon. Gentleman is talking about a mandate in the Lords, he might like to tell his colleagues that at the last election his party was elected on the basis of supporting foundation trusts, for example, to be able to be free to increase their private income.
Mr John Redwood (Wokingham) (Con)
Am I right to tell my constituents that the purpose of this reform is to give more choice of care to patients, and to give more power to GPs to deliver better free treatment?
Mr Ben Bradshaw (Exeter) (Lab)
Given that the right hon. Gentleman inherited an NHS with record short waiting times, record high public satisfaction and improving competitiveness, does he ever in his darkest moments wish that he had not embarked on this damaging and costly upheaval?
Mr Lansley
At the last election the average waiting time for in-patient treatment was 8.4 weeks. In December 2001, when the most recent data were published, it had come down to 7.7 weeks. The right hon. Gentleman might like to reflect on the fact that the number of people waiting more than a year for treatment in the NHS is now more than half what it was at the last election.
Simon Hughes (Bermondsey and Old Southwark) (LD)
I thank the Secretary of State for accepting many of the amendments to the Bill proposed by our colleagues and others and thank his colleague in the House of Lords for accommodating not only Liberal Democrat and Cross-Bench peers, but Labour peers who have joined us in bringing forward such amendments. Will he give an undertaking to continue to work collaboratively to improve the Bill to the very end and reject Labour’s allegations that it did not force privatisation on the NHS, which we are definitely not doing?
Mr Lansley
I am grateful to my right hon. Friend and thank him for his positive remarks about my noble Friend Earl Howe. I attach to that my appreciation to Baroness Northover for the work she has been doing in another place and to the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, who has been heavily engaged in discussing some of the amendments. I recall that nearly a year ago there was a clear expression of interest from the Liberal Democrats, as a party, on how they felt the Bill should be improved. I was pleased that we were able to bring forward changes that reflected virtually all those. Indeed, they are reflected directly in what my right hon. Friend the Deputy Prime Minister said in his letter yesterday.
Mr Kevin Barron (Rother Valley) (Lab)
If the competition in the Bill is just an extension of what the previous Government did by introducing independent sector treatment centres and everything else, why are more than 90 clauses writing into the law of the land that competition policy should run the NHS, not the NHS, as has been the case in the past?
Mr Lansley
I would not characterise this as an extension of the independent sector treatment centres programme. That is precisely what we do not need to do with the private sector. Under the Labour Government, the private sector was paid 11% more than the NHS, which was wrong, and in another place there is a legislative provision that will prevent discrimination in favour of the private sector. The Bill will carry forward exactly the principles and rules of co-operation and competition, as reflected in the panel set up under the previous Government. As NHS Future Forum set out, the reason for having that in the Bill, with Monitor exercising those responsibilities, is so that there will be a health sector regulator, rather than that being done without health expertise by the Office of Fair Trading.
Nadine Dorries (Mid Bedfordshire) (Con)
Some Conservative Members never criticised, and in fact supported, the previous Government when they introduced private health care providers into the NHS. In his letter, the Deputy Prime Minister said that the use of private health care firms has been explicitly prevented as a result of his involvement. Is that really true? If so, should someone not tell him who is running this Government?
Mr Lansley
My hon. Friend knows perfectly well that we are a coalition Government and, therefore, this is a coalition Bill that reflects the views of the whole coalition. To that extent, I reiterate to her and to the House that, as the Deputy Prime Minister has quite rightly said, the legislation will not allow discrimination in favour of the private sector in the way that the Labour party did.
Mr Dennis Skinner (Bolsover) (Lab)
All those royal colleges, all those nurses and all those doctors know that this Bill is about privatisation. Along come these tin-pot Liberals, who put forward an idea to make a few marginal shifts. It is the biggest con trick of all time. This is about trying to save the face of those people, who should have opposed the Bill from the very beginning. Drop this lousy Bill.
Mr Lansley
I will tell the hon. Gentleman exactly what the Bill is about: improving care for patients. That is what I care about, and it ought to be what he cares about. [Interruption.]
Mr Peter Bone (Wellingborough) (Con)
There is an old political saying that the Liberal Democrats say one thing at one end of their constituency and another thing at the other end. Will the Secretary of State lay that rumour absolutely to rest—that they are not saying one thing at this end of Parliament and another thing at the other end?
Mr Lansley
I am happy to be able to tell my hon. Friend that I, with my colleagues, have had very constructive engagement with my Liberal Democrat colleagues in government and, indeed, during the course of our debates in another place.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
Following the question from the hon. Member for Mid Bedfordshire (Nadine Dorries), can the Secretary of State tell us when he was aware of the letter, whether he was consulted on it and whether he had any input?
Mr Lansley
I believe that I answered that question. The point of the letter was to reflect the discussions that we have been having.
Mr John Baron (Basildon and Billericay) (Con)
Does my right hon. Friend accept that the debate so far risks ignoring the importance of the Bill’s renewed outcomes? In cancer, for example, such focus is instrumental in driving forward earlier diagnosis, which in itself could save quite literally thousands of lives.
Mr Lansley
My hon. Friend is absolutely right, and I am sure that in that context he shares with me the appreciation of the benefit that will come from campaigns to promote the early awareness of cancer, such as, following piloting, the roll-out of the national campaign for the awareness of bowel cancer symptoms.
John Healey (Wentworth and Dearne) (Lab)
Is not this another attempted PR and political fix for a mismanaged health Bill that is again in chaos? Which of the changes set out in the Deputy Prime Minister’s letter was not agreed in government first?
Mr Lansley
Would that be the same Bill that the right hon. Gentleman described as “consistent, coherent and comprehensive”?
Conor Burns (Bournemouth West) (Con)
May I ask the Secretary of State today to confirm again that when the Bill becomes law the national health service will remain funded through taxation and free at the point of use regardless of ability to pay? Opposition Front Benchers should stop scaring our constituents with grossly inappropriate scare stories.
Mr Lansley
My hon. Friend is absolutely right, and I share his deep resentment at the way in which Opposition Members misrepresent and distort what is in the legislation and then, when people write to us concerned about what is in the legislation, accuse us of not listening to them. Opposition Members should read what is in the Bill, find out that it achieves the purposes that my hon. Friend describes and not distort it.
Mr Speaker
Order. I simply say to the Secretary of State that to refer to somebody “distorting” something is perfectly in order, but I know that he would not want to use an unparliamentary term and talk about anything being “misrepresented”. I think he is accusing a Member of being erroneous. I think that is what he has in mind.
Grahame M. Morris (Easington) (Lab)
There is clearly no mandate, either in this House or in the other place, for these huge changes and massive top-down reorganisation. Some 162,000 people have signed an e-petition calling on the Government to drop the Bill, so may I remind the Secretary of State that his own party’s election manifesto stated that
“any petition that secures 100,000 signatures will be eligible for formal debate”?
Does he not think that it is time for us to have a full debate about the issue, to find out who is in favour and who is against and to drop the Bill?
Mr Lansley
The hon. Gentleman, himself, was present at 40 sittings in Committee, during which his hon. Friend the Member for Halton (Derek Twigg), the shadow spokesman, said that the Bill had been thoroughly scrutinised. We have debated it; in another place they continue to debate it very fully and very constructively; and I believe that that will deliver us the right Bill for the NHS.
Andrea Leadsom (South Northamptonshire) (Con)
Will my right hon. Friend confirm that this Bill is superb news for patients, and that under the Secretary of State’s new Bill, my constituent who requires less invasive hip treatment in a neighbouring county will be able to choose to go to that other provider for a less expensive operation that will do him less harm and more good?
Mr Lansley
Yes, indeed. For the first time, not just through the legislation but through the modernisation of the national health service, patients will be able to see, through the data, the quality of the service provided in the NHS by a range of providers. When patients are asked whether they want—on that basis, as NHS patients with a free service based on their need—to be able to choose who should provide them with care, 81% say that they want that choice. We will give them that choice; Labour would not.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Deputy Prime Minister’s letter promised
“additional safeguards to the private income cap”.
Will the Secretary of State explain what are these additional safeguards aimed at ensuring that foundation trusts cannot focus on private profits before patients?
Mr Lansley
We have already made it very clear in another place that the legislation will ensure that foundation trusts should have the freedom to increase their private income, not least in relation to international work. However, their principal legal purpose is for the benefit of NHS patients, and so they already have to make sure that they reflect that in their annual reports and in their annual plans. As the letter indicates, we are, with my hon. Friends in another place, working on a further corporate governance mechanism to ensure that foundation trusts reflect their principal legal purpose in all that they do. [Interruption.]
Mr Speaker
Order. I want to hear the questions and the answers. Members are a little overexcited and they need to calm down just a tad. A good example of such calm will now, I am sure, be provided by Mr John Hemming.
John Hemming (Birmingham, Yardley) (LD)
Under Labour, local democratic accountability in the NHS was reduced by the abolition, without consultation, of the community health councils. The letter refers to the creation of the health and wellbeing boards, which will increase local democratic accountability for the health service. Will the Secretary of State explain how that will ensure that local services in the health service better fit local health needs?
Mr Lansley
That is a very powerful and positive step forward. Through the joint strategic needs assessment and the strategy derived from that, local authorities and the NHS will now increasingly work together to deliver integrated services extending across health, social care and public health.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Will the Secretary of State please confirm whether all the changes outlined in the Deputy Prime Minister’s letter now represent Government policy?
Mr Lansley
The Deputy Prime Minister’s letter accurately reflects the discussions that we have been having in another place—[Interruption] I do not see why that is funny; it is very simple—in anticipation of the amendments that will be debated there on Report.
Dr Phillip Lee (Bracknell) (Con)
The previous Labour Government, of whom the shadow Secretary of State for Health was an active member, negotiated private finance initiative contracts that are costing the NHS almost £3,000 per minute. Will the Secretary of State detail what his Department and the Treasury are doing to help to alleviate this enormous level of debt, which has risked the viability of some NHS services?
Mr Lansley
We are helping all trusts with PFI contracts to manage the costs of those contracts. Seven trusts were left with unsustainable PFI contracts, and we have made it clear that we are willing to help support them. Labour Members—they are not even listening—are distorting the nature of this legislation, which does not permit privatisation. Given that during their time in office they left the NHS with 102 hospital projects owned, in effect, by the private sector, with a PFI debt of £67 billion, it is outrageous for them to sit there pointing fingers at us.
Mr David Winnick (Walsall North) (Lab)
If this is such a marvellous measure that protects the NHS, as the Secretary of State has been saying, why is it opposed by virtually all those in the medical profession and by most of the public, to the extent that he has become almost a hate figure? Is it because he lacks persuasiveness or because this is a worthless Bill that will undermine the NHS?
Mr Lansley
The hon. Gentleman should go and talk to the clinical commissioning groups across the country that are delivering on the clinical leadership that will modernise and improve the NHS rather than simply sitting reading the newspapers and imagining that he knows what is going on in the NHS.
Philip Davies (Shipley) (Con)
Does my right hon. Friend agree that when she was in government, Baroness Williams was one of the chief architects of ruining the state education system in this country? Given that, why would a Conservative-dominated Government wish to dance to her tune?
Mr Lansley
My right hon. and noble Friend Baroness Williams is now a member of the Liberal Democrat party, and in that respect I am not aware that she has ever transgressed in government.
Paul Goggins (Wythenshawe and Sale East) (Lab)
Last year, when the Bill was in its infancy, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), gave me an assurance that NHS services in Trafford undergoing changes would not be privatised. In the light of all the amendments, is the Secretary of State able to offer me the same assurance, especially given that the Co-operation and Competition Panel in his Department has instructed the local NHS to devise a contract that is divided into six separate lots, with a warning that competition must be prosecuted, otherwise there will be severe consequences?
Mr Lansley
I can give the right hon. Gentleman the same reassurance that the Minister of State gave.
Mrs Anne Main (St Albans) (Con)
Will my right hon. Friend confirm that the previous Government were, in 2006, given the advice that it was neither possible nor desirable to ensure that competition was not allowed in the NHS because it is subject to EU competition rules?
Mr Lansley
I am glad that my hon. Friend has made that important point. People such as the former Chair of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), who is no longer in his place, are fond of asking why we are introducing competition into the NHS. We are not. The Bill does not introduce competition to or extend competition within the NHS. The legal advice disclosed in one of today’s national newspapers makes it clear that the previous Labour Government introduced the reach of competition law into the NHS by introducing the elective choice programme in 2006.
Angela Smith (Penistone and Stocksbridge) (Lab)
If the Health Secretary believes so much in the value of his Bill, why did he not take the time to explain it to voters before the general election, instead of promising that there would be no top-down reorganisation of the NHS?
Mr Lansley
I refer the hon. Lady to pages 46 and 47 of the Conservative party manifesto and, to understand the Bill fully, to the Liberal Democrat manifesto.
David Tredinnick (Bosworth) (Con)
I encourage my right hon. Friend to read the minutes of the Hinckley and Bosworth health and wellbeing partnership meeting. He will see that clinical commissioning groups are in place and that there is a priority on early intervention. There is support for the health and wellbeing board and its priorities. Does that not go completely against what we are hearing from Opposition Members?
Mr Lansley
I had the pleasure—before Christmas, I think—of meeting the local authority, the director of public health and the three clinical commissioning groups from across Leicestershire, who are all enthusiastic about the opportunities presented by the modernisation of the NHS legislation.
Mr Dave Watts (St Helens North) (Lab)
Is it not clear to even this Secretary of State that the Bill is now a dog’s breakfast? Given that doctors, nurses, the public, the Lords and many Government Members oppose the Bill, what mandate does he have for such a radical change of the NHS?
Mr Lansley
I refer the hon. Gentleman to the point I made about the mandate. Beyond the mandate, staff across the NHS have been clear for years that they want more clinical leadership and clinically led commissioning; they want local authorities to integrate health and social care services more effectively; and they support the transfer of leadership in health improvement into the hands of local authorities. The Bill achieves those principles. That is why all through last year, the Royal College of Nursing told me that it supported the Bill.
Penny Mordaunt (Portsmouth North) (Con)
The Secretary of State is not the only one who has noticed a shift in the Opposition’s stance on independent sector provision. I have started to receive letters from constituents who are concerned that Labour will next call for much-loved NHS services that are currently provided by the independent and charitable sectors to be shut down. Will he assure me that if those calls are made, he will fight them?
Mr Lansley
My hon. Friend makes an important point about what would happen if we followed the apparent views of the Labour party. More than 11% of mental health services in this country are provided by the private and charitable sectors. Recently, I was in Northampton, where St Andrew’s Healthcare provides important services. I opened its new building, which will provide first-rate, state-of-the-art care for mental health patients. The attitude of the Labour party is that all that should be shut down.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Up and down the country, thousands of NHS staff have already been laid off—so much for no top-down reorganisation—and many of them are being re-employed at vast expense. When will the Secretary of State publish the costs to date, before the Bill is even law, of this overarching reorganisation?
Mr Lansley
I do not know whether the hon. Lady has read the latest monthly data on the NHS work force, but since the election the number of non-clinical staff has gone down by 15,000, including the number of managers by 5,800, and the number of clinical staff has risen, including more than 4,500 more doctors.
Jane Ellison (Battersea) (Con)
My constituency has considerable health inequalities, so I very much welcome the fact that tackling health inequalities is at the heart of the Bill. Does the Secretary of State share my surprise that the Opposition do not similarly welcome that?
Mr Lansley
I have to tell my hon. Friend that nothing much about the Opposition surprises me any more.
Alex Cunningham (Stockton North) (Lab)
Will the Secretary of State now accept that, contrary to the impression he is trying to create, the opposition to his muddled bill is not some plot by health workers or trade unions with vested interests, but is coming from many Liberal Democrats, the majority of the British public and almost the entire health community, to whom his Government promised to listen?
Mr Lansley
Opposition Members distort what is in the Bill and tell their constituents that it is something other than what it is, and then they come to the House and say, “Oh, it’s muddled.” It is not muddled at all; it is they who are muddled.
Dr Sarah Wollaston (Totnes) (Con)
I do not know any GPs who want to see inappropriate use of the private sector. They will be doing the commissioning and the public will be able to see what they are doing. Should we not let them get on with it?
Mr Lansley
My hon. Friend is absolutely right. I was very pleased to hear what was said by Dr Sam Barwell—I think her name is Barwell.
Mr Lansley
Barrell. One had only to listen to how Dr Sam Barrell and her colleagues in the Baywide clinical commissioning group in my hon. Friend’s constituency are providing clinical leadership in south Devon and Torbay to be absolutely clear that the Bill is right to give them that responsibility and that they will use it extremely well.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
If the Deputy Prime Minister’s letter agreed with the Secretary of State, as the Secretary of State has confirmed today, can he explain why the Minister of State, Department of Health, the right hon. Member for Chelmsford, said on Radio 4 yesterday that there would be no further changes to the Government’s Bill?
Mr Lansley
My right hon. Friend and I are very clear that, as I explained—really quite carefully, I thought—it is customary in another place for some of the issues that have been debated to be reflected in amendments on Report, and that is what will happen.
Charlie Elphicke (Dover) (Con)
Can the Secretary of State confirm that the principles underpinning the Bill are that the NHS is and will remain free for all patients; that a person’s GP knows them and their needs best; and that although we are spending billions of pounds more than Labour would have done, every pound needs to work as hard as possible if the NHS is to be modern and provide care for the future?
Mr Lansley
My hon. Friend is right, not least on his point that the coalition Government are investing in the NHS, with real-terms increases each year. That contrasts with the Labour Government in Wales, who in the course of this Parliament intend to reduce spending on the NHS by more than 6% in real terms.
Jim Shannon (Strangford) (DUP)
At a very lively Conservative away-day last Friday, a document was issued that stated:
“If we changed or altered the bill now, we would end up in a no man’s land, and chaos.”
Four days later, can the Secretary of State confirm the Government’s position?
Mr Lansley
The Government’s position is that there has been very constructive debate in Committee in the Lords, and I look forward to that being reflected in equally constructive debates on Report.
Duncan Hames (Chippenham) (LD)
Liberal Democrats hate Labour’s health reforms, which result in hospitals being paid for operations whether they happen or not. Does the Secretary of State consider that the NHS, for which he remains responsible, would be in better health had Labour’s reforms been subjected to the parliamentary scrutiny that his have?
Mr Lansley
My hon. Friend makes an extremely good point. Many of the issues that have been the subject of some of the most heated debate on the Bill have been raised because Labour never addressed them. He is absolutely right that one result will be that in future, it will no longer be possible for £250 million to be paid to the private sector for operations that never take place.
Helen Jones (Warrington North) (Lab)
Can the Secretary of State explain why he is prepared to get into further discussions with the Liberal Democrats to help them to save seats in May, but not to do so with doctors, nurses and midwives, who all oppose the Bill? Is he engaged in patching up the coalition rather than in providing proper health care?
Mr Lansley
I think I made that perfectly clear not only in the course of the initial consultation on the White Paper, but then through the NHS Future Forum. Many thousands of NHS staff contributed their views to the NHS Future Forum, which made many recommendations and we accepted them all.
Chris Skidmore (Kingswood) (Con)
Is it not the case that the text of the letter merely reflects the Government’s amendments on Lords Report? The Opposition really should have done their homework, because it has been on the website since 1 February. They are four weeks out of date.
Mr Lansley
My hon. Friend is right up to a point. On Report in the other House, amendments reflecting the debate in Committee will be tabled. They might not all be Government amendments, but I am looking forward to constructive amendments. As I have said, if amendments from Liberal Democrat or indeed Labour peers are constructive and will help to improve the Bill, we will accept them.
Thomas Docherty (Dunfermline and West Fife) (Lab)
Will the Secretary of State clarify whether the changes are significant, as stated by the Deputy Prime Minister, or merely reassurance, as stated by the Prime Minister’s official spokesperson?
Mr Lansley
The amendments on Report that we will support will, by their nature, be significant.
Mr Rob Wilson (Reading East) (Con)
Will my right hon. Friend assure my constituents that our NHS reforms will outlaw the practice common under the previous Government of the private sector being paid more than the NHS for exactly the same operation?
Mr Lansley
Yes, that is absolutely correct. For the first time, we will have a provision in law that prevents the kind of discrimination in favour of the private sector that was practised in government by the Labour party.
Derek Twigg (Halton) (Lab)
In an article in The Guardian on 13 February, Baroness Williams said:
“The way out of this mess is not hard to find… What that would mean for the bill would be dropping the chapter on competition”.
Will the Secretary of State clarify whether he is willing to accept such an amendment from Baroness Williams?
Mr Lansley
As I understand it, I have come to the House to answer questions about a letter, jointly signed by the Deputy Prime Minister and Baroness Shirley Williams, which does not say that.
Christopher Pincher (Tamworth) (Con)
In 2007, when he was Secretary of State, the shadow Secretary of State waxed eloquent, saying that he celebrated the private sector in the NHS. Has my right hon. Friend any clue to what changed the right hon. Gentleman’s mind?
Kate Green (Stretford and Urmston) (Lab)
The Secretary of State said this afternoon that competition will not be allowed to get in the way of sensible integration of services, so why is Trafford Healthcare proceeding with the commissioning of provider services in six penny packets, as described by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins)? How can that support the sensible integration of services?
Mr Lansley
The hon. Lady must be aware that under the Bill, we will move from primary care trusts that, under current public procurement rules, are very often not capable of integrating services as they would want, to clinical commissioning groups, which will have the freedom and power to do so.
Andrew Selous (South West Bedfordshire) (Con)
Will my right hon. Friend confirm that clauses 22 and 25 of the Bill remain, which for the first time ever put a duty on the Government to deal with health inequality.
Mr Lansley
I am grateful to my hon. Friend. That is indeed true, and it gives the lie, if you will forgive me, Mr Speaker, not to anybody in the House, but to those who would represent the legislation as having the effect of widening health inequalities. Health inequalities widened under the Labour Government. For the first time, our legislation will place on all NHS bodies and the Secretary of State a duty to tackle and reduce health inequalities.
Rushanara Ali (Bethnal Green and Bow) (Lab)
The Secretary of State will know that Tower Hamlets clinical commissioning group in my constituency has decided today to ask the Government to drop the Bill, citing the bureaucracy it will generate as a key reason. When the structures he has established to advise him tell him that they want no part in the nightmare that he is creating, is it not time to think again and drop the Bill?
Mr Lansley
I have been to Sam Everington’s practice in Bromley-by-Bow, which has been gearing itself up. It will use the powers in the Bill and will do so very effectively.
Harriett Baldwin (West Worcestershire) (Con)
Foundation trusts will be given the freedom to increase private services and patients will have the right to choose any provider that meets NHS standards. Was the Secretary of State as surprised as I was to learn that that was in the Labour party’s 2010 manifesto?
Mr Lansley
I am grateful to my hon. Friend. I suppose that we should not be surprised that the Labour party in opposition has abandoned everything it said in government, but for it to abandon so quickly so many of the things it said even in its manifesto is pretty dramatic.
Jonathan Ashworth (Leicester South) (Lab)
If I may say so, I think that the Secretary of State and the Government have been at sixes and sevens over this issue in recent weeks and they would be better off dropping this disastrous Bill. However, may I press the right hon. Gentleman on the answer he gave to my hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty)? If he now agrees that the amendments are significant, as the Deputy Prime Minister has boasted, does that mean that the Prime Minister’s spokesperson was wrong to downplay them as a mere reassurance?
Mr Lansley
I am clear that sometimes we need to ensure through amendments that we not only achieve the effect that we intend, but reinforce it in legislation. Some of them will reassure, and some will have significant effects directly on the governance of the NHS.
Brandon Lewis (Great Yarmouth) (Con)
To avoid the continuation of the erroneous—that is the word, I think—statements from the Opposition, will my right hon. Friend confirm that the GP survey continually referred to was filled in and returned by about 6% of GPs only, and therefore is not reflective of the views of GPs across the country, such as those at HealthEast, who are keen to get on with commissioning quality health care for their patients?
Mr Lansley
Yes, I have the benefit, as do many of my colleagues on the Government Benches, of talking to GPs across the country, individually and in clinical commissioning groups. The issue to address is not the distortion of legislation and its effects but realising benefits for patients. That is where we are. We want to achieve and improve quality for patients. That is where GPs are, where nurses are and where doctors and health professionals are. The legislation is part of the broader process of devolving responsibility to them and patients to allow that to happen.
Caroline Lucas (Brighton, Pavilion) (Green)
What is the Secretary of State most worried about: the frightening chaos of the billion pound commissioning underpinning the reforms that will benefit Circle health care, United Health, PricewaterhouseCoopers, KPMG, McKinsey and the rest at the expense of patients; or the personal embarrassment that he would feel if he did what he should do—if he listened to the professionals and the thousands of people who have signed the e-petition—and dropped the Bill?
Mr Lansley
I will tell the hon. Lady what most frightens me: it is that if we had carried on the inheritance from Labour, with waste and bureaucracy escalating and a year-on-year reduction in productivity in the NHS, in a financially challenged environment the quality of patient care would have suffered. At the moment, we have an NHS that is doing magnificently well at raising performance across the service while transforming itself to meet future challenges.
Angie Bray (Ealing Central and Acton) (Con)
This feels like groundhog day—nothing ever seems to change. Every time the Labour party brings this issue to the House, we hear the same statements, questions and scaremongering. Does the Secretary of State agree that we hear nothing new from the Labour party? All we hear is the same scaremongering—nothing new, no new thinking.
Mr Lansley
I bring good news to my hon. Friend. Out there in the real world, things are changing: there are clinicians, doctors and nurses across the country who are taking the opportunity of this responsibility to improve services for patients; there are patients who realise that they will get additional voice and choice; and there are local authorities that realise that, through their health and wellbeing boards, they can use this to drive improvements in health for their population. Those are the things that are changing. Unfortunately, not only is the Labour party not changing but it is going backwards.
Diana Johnson (Kingston upon Hull North) (Lab)
I listened carefully to the Secretary of State’s answer to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), but it struck me as gobbledegook. Will he spell out in plain English the additional safeguards to the private income cap that the Deputy Prime Minister is seeking to ensure that foundation trusts cannot focus on private profit before patients?
Mr Lansley
The hon. Lady will have to look at the amendments tabled in the other place tomorrow.
Jeremy Lefroy (Stafford) (Con)
Will my right hon. Friend detail for the House how the Bill will help to improve patient safety and quality of care, which are so important to my constituents and those of everybody in the House?
Mr Lansley
I am grateful to my hon. Friend, because there are a number of ways in which I think this issue will be important. First, for the first time, how we improve patient safety will be published in a consistent way, as one of the five domains of the outcomes framework. Secondly, that will be demonstrated by achievement—for example, we have the lowest ever levels of methicillin-resistant Staphylococcus aureus and clostridium difficile infection. Thirdly, the NHS Commissioning Board, which will be established under the legislation, will take national responsibility for the delivery of patient safety, linking it directly to commissioning, whereas in the past the National Patient Safety Agency was an organisation on its own and was not directly linked to the exercise of commissioning responsibility.
Stephen Mosley (City of Chester) (Con)
In Chester, we are seeing the effects of tens of thousands of patients fleeing the NHS in Wales to seek better treatment in England. Will my right hon. Friend reassure my constituents that there is nothing in the Bill that will cause the English NHS to be as bad as what we see over the border in north Wales?
Mr Lansley
Not only are the Labour Government in Wales cutting the budget of the NHS, where we are increasing it, but the situation is as my hon. Friend describes, with 91.6% of patients in England being seen and treated within 18 weeks, whereas in Wales the comparable figure is just 68%.
Jason McCartney (Colne Valley) (Con)
This urgent question has been very much a repeat of last Wednesday’s lengthy debate. Does my right hon. Friend agree that the last 50 or so minutes has been more about spiteful politics than about policy and patient care?
Mr Lansley
I agree with my hon. Friend, but fortunately this urgent question has given me another opportunity to remind everybody in this House and beyond that this Government’s purpose is to empower patients, get front-line doctors and nurses in charge in the NHS, cut our tiers of bureaucracy and improve the quality of care for patients.
Mr Speaker
I thank colleagues for their succinctness, which enabled 53 Back Benchers to question the Secretary of State in 42 minutes of exclusively Back-Bench time. I am indebted to the House.
Under the terms of Standing Order No. 24, I now call Mr William Cash to make an application for leave to propose a debate on a specific and important matter. As I am sure the hon. Gentleman will know, he has three minutes in which to make such an application.
Health Select Committee Report on Public Expenditure (Government Response)
Lord Lansley Excerpts(12 years, 8 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government response to the House of Commons Health Committee’s report “Public Expenditure: Thirteenth Report of Session 2010-12” (Cm 8283). The Committee’s report was published on 24 January 2012.
The modernisation and efficiency challenges we are seeking across health and social care are exceptional; ones that are vitally necessary to secure sustainable and improving services. They are also inextricably linked and mutually supportive. These changes are critical to bringing about a modern care system that is fit to deliver the high quality, responsive, personalised services wanted by people today. As a part of these reforms, we are protecting funding for the NHS and allocating additional funding for social care.